Avascular necrosis of bilateral femoral head as a result of long-term steroid administration for radiation pneumonitis after tangential irradiation of the breast

Perthes' disease is a disorder of the hip joint in children. Femoral head became softens, flattened or deformed because of the lack of blood supply of unknown cause. It is a very rare cause of bilateral avascular necrosis of the head of the femur, which can easily diagnosed by clinical correlation with the X-ray pelvis findings. Here we present a typical case of Perthes disease, who was finally diagnosed after a long periods of time. In Perthes disease early detection is very important to preserve, restore the femoral head, relieve pain and prevent long term osteoarthritis. DOI: http://dx.doi.org/10.3329/akmmcj.v4i1.13684 AKMMC J 2013: 4(1): 40-41

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Membrane Microparticles from Patients with Steroid-Induced Avascular Necrosis of Femoral Head Increase the Expression of Fas in Endothelial Cells In Vitro.

Blood ◽

10.1182/blood.v110.11.3903.3903 ◽

2007 ◽

Vol 110 (11) ◽

pp. 3903-3903

Author(s):

Xi-sheng Weng ◽

Zhi-hong Wu ◽

Yi Wei ◽

Gui-xing Qiu

Keyword(s):

Endothelial Cells ◽

Femoral Head ◽

Avascular Necrosis ◽

Umbilical Vein ◽

Cell Types ◽

High Dose ◽

Necrosis Of Femoral Head ◽

Membrane Microparticles

Abstract High-dose or long-term usage of steroid have been suggested to be at great risk of developing avascular necrosis of femoral head (ANFH). A theory proposed to decipher the mechanism behind the development of steroid-induced ANFH involves vascular compromise and cell death. Membrane microparticles (MMPs) are fragments shed from plasma membrane blebs of virtually all cell types when submitted to a number of stress conditions, including apoptosis. It has been reported that high-dose dexamethasone cause dysfunction and apoptosis of endothelial cells; and MMPs isolated from the plasma of patients with myocardial infarction of preclampsia were found to cause damage in isolated arteries in vitro. We hypothesize that MMPs generated after high-dose or long-term administration of steroid facilitates the apoptosis of endothelial cells initiated by steroid, which contributes to the development of ANFH. MMPs were isolated from the blood of 4 healthy individuals, and 5 patients demonstrated to have ANFH by magnetic resonance imaging (MRI) and X-ray. The mean duration and accumulated dose of steroid administration were 8 months and 2000 mg respectively. The 3rd generation of human umbilical vein endothelial cells (HUVEC) was exposed to MMPs (corresponding to 0.2-fold circulating plasma level) prepared above. After 48 hours, part of cells was lysed to make total cell lysate. And the rest were used to prepare mRNA. The expression level of Fas was detected with reverse-transcript PCR and Western Blot. Our results shown that treatment of HUVEC with MMPs from ANFH patient’s blood significantly increases the transcription and expression of Fas, indicating that MMPs derived from patients with steroid-induced ANFH exacerbates high-dose steroid-induced apoptosis of endothelial cells by enhancing the expression of Fas.

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Long-term Outcome of Multiple Small-diameter Drilling Decompression Combined with Hip Arthroscopy versus Drilling Alone for Early Avascular Necrosis of the Femoral Head

Chinese Medical Journal ◽

10.4103/0366-6999.207470 ◽

2017 ◽

Vol 130 (12) ◽

pp. 1435-1440 ◽

Cited By ~ 5

Author(s):

Ji Li ◽

Zhong-Li Li ◽

Hao Zhang ◽

Xiang-Zheng Su ◽

Ke-Tao Wang ◽

...

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Hip Arthroscopy ◽

Small Diameter ◽

Term Outcome ◽

Long Term Outcome

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Allicin inhibits osteoblast apoptosis and steroid-induced necrosis of femoral head progression by activating the PI3K/AKT pathway

Food & Function ◽

10.1039/d0fo00837k ◽

2020 ◽

Vol 11 (9) ◽

pp. 7830-7841 ◽

Cited By ~ 2

Author(s):

Jingdi Zhan ◽

Zijian Yan ◽

Mengyao Zhao ◽

Weihui Qi ◽

Jian Lin ◽

...

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Major Complication ◽

Akt Pathway ◽

Clinical Use ◽

Osteoblast Apoptosis ◽

Necrosis Of Femoral Head

Steroid-induced avascular necrosis of the femoral head (SANFH) is a major complication of long-term or excessive clinical use of glucocorticoids.

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The first experience of arthroscopy in the case of aseptic necrosis of the femoral head

ORTHOPAEDICS TRAUMATOLOGY and PROSTHETICS ◽

10.15674/0030-59872021239-44 ◽

2021 ◽

pp. 39-44

Author(s):

Maxim Golovakha ◽

Vadym Kirichenko ◽

Olexandra Grytsenko ◽

Rostyslav Tytarchuk ◽

Stanislav Bondarenko

Keyword(s):

Femoral Head ◽

Avascular Necrosis ◽

Hip Joint ◽

Comparison Group ◽

Long Term Results ◽

Control Group ◽

Study Group ◽

Hip Joint Replacement ◽

Therapeutic Exercises

Observation of patients with avascular necrosis of the femoral head formed a hypothesis about inability to eliminate the hip contracture by tunneling the femoral head on the background of drug therapy and therapeutic exercises, which causes an unsatisfactory outcomes. Therefore, the was idea to use arthroscopy for performing capsulotomy, synovectomy and removal of free cartilage and bone fragments. Objective. To evaluate efficiency of arthroscopy in patients with avascular necrosis of the femoral head. Methods. In the period from 2010 to 2018, 60 patients were observed. With the I–II stages, absence of inflammatory processes in the joint, body mass index less than 35. In the comparison group (28 patients) we made only tunneling of the femoral head, in the study group (32) at first we performed arthroscopy of the hip joint, capsulotomy, synovectomy, removal of cartilage fragments, and only then — tunneling. We analyzed the proportion of hip joint replacement that was performed in the long term follow up and the intensity of pain by visual analog scale. Results. During arthroscopy we often revealed the joint cartilage lesions — 30 %, articular labrum lesions — 5 %, synovitis — 100 %, CAM impingement — 90 %. In the study group in the first 2 weeks after surgery, the pain was severe more than in the comparison group. Then the pain rate became the same in both groups. In the control group in the period from 3 to 5 years after tunneling of the femoral head, arthroplasty was performed in 11 patients (39.3 %), in the study group for 2 to 3 years after surgery — 8 (25.0 %). Conclusions. Analysis of long-term results of tunneling of the femoral head with arthroscopy of the hip joint in patients with avascular necrosis of the femoral head showed improvement in hip function, no disease progression in 60–75 % patients in 2–3 years after surgery.

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